This invention relates to the fields of medical patient physical therapy, the apparatus used in such therapy, and to medical measuring apparatus.
Several classes of medical patients are known to incur difficulty in performing the swallowing function used routinely by normal persons in eating and drinking. Particularly, surgical patients who have undergone cancer-related head and neck surgical procedures are known to experience this swallowing difficulty or dysphagia in an extreme form. Surgeries such as tonsil and soft palate resection with primary tongue closure, partial glossectomy, extended supraglottic laryngectomy with base of tongue resection, and partial and complete pharyngectomy are examples of the life-saving but drastic procedures that are found to initiate great difficulty in recovering the ability to perform a normal swallowing function.
Frequently, patients of this type, especially those receiving post-operative radiation treatment, require a prolonged period of hospitalization, tube feeding, and slow progress --progress extending over many months of hospitalization, in order to achieve even a limited degree of normal swallowing ability. Unfortunately, experience has also shown that many of these patients can never return to normal eating and drinking and require lifelong tube feeding because of a permanently impaired swallowing reflex.
In addition to a need for assisting patients of this type in the recovery of swallowing ability, patients in these surgical categories who are fortunate enough to retain the vocal cord and voice box structures in the area of surgery are often nevertheless faced with an inability to use these structually unaffected components as a result of nerve and muscle impairment that is collateral to the surgical procedure.
It also is often found that patients with non-surgical neurological and neuromuscular disorders--such as head injuries, cerebro-vascular accidents or strokes, amyo-tropic lateral sclerosis (ALS) or Lou Gehrig's disease, and other disorders can be faced with swallowing and speaking impairments of significant proportion.
A particularly troublesome effect of all of these surgical and disease-related dysphagia disorders arises from an inability of patients with such conditions to escape aspiration of food into their larynx, trachea, or windpipe during the act of swallowing. This condition results in considerable discomfort to the patient and presents the repeated threat of choking, airway distress, and possibly pneumonia. It is, in fact, the food and liquid aspiration threat which usually causes the long-term or permanent loss of normal eating and drinking in these patients.
It is now known that many of these surgical and disease patients can respond favorably to a regimen of dysphagia therapy that is directed to strengthening the base of tongue (BOT) region of the throat and neck. Such patients can therefore frequently be significantly assisted by persistent therapy routines which recondition and strengthen the retained muscle and nerve functions attending the swallow. Such strengthening of the BOT area increases the patient accomplished pulsion force in the pharynx and this improvement helps drive the bolus or liquid or chewed food mass through the pharynx in an aspiration-free proper swallowing sequence.
The patent art includes several examples of patient responsive or patient energized apparatus that are useful in the therapy field. Included in this patent art is the volumetric spirometer of George Puderbaugh disclosed in U.S. Pat. No. 4,324,260; the incentive spirometer employing a bellows airflow sensor of Philip Choksi as disclosed in U.S. Pat. No. 4,635,647; and the respiratory training using feedback of Michael Bellman in U.S. Pat. No. 4,981,295. Although each of these patents discloses a measuring system capable of providing feedback to a using patient, it is notable that all of these patents involve measuring systems which are intended for positive pressure use with the lungs.
Also included in the patent art is the suction operated nebulizer of Robert A. Varag, as disclosed in U.S. Pat. No. 4,198,969. Although the Varag apparatus does operate in response to suction or negative pressure, it is notable that this pressure also originates in the patient's lungs and that a primary purpose of the invention is to supply liquid into a stream of gas and deliver this mixture into the patient's lungs.
None of these prior patent examples therefore considers the problem addressed by the present invention, including the incentive rewarding of a patient while performing a therapy related act of oral sucking.